Getting healthy—and staying healthy

Hospitals want to keep you from boomeranging back in

SAN FRANCISCO (MarketWatch)—Hospitals have a new incentive to help keep you from boomeranging back to them shortly after you’ve been sent home or to another care facility.

Starting in October, general hospitals will begin losing a portion of their Medicare payments if too many patients are readmitted within 30 days of being discharged for pneumonia, heart failure or heart attack, according to a provision in the health-care law.

More than 2,200 hospitals are affected this year. Medicare payments to hospitals will be reduced by 0.3%, or nearly $300 million, says Nancy Foster, vice president for quality and patient-safety policy for the American Hospital Association, a trade group in Washington.

The rules are designed to improve health-care quality and lower costs for Medicare beneficiaries. The penalties and list of applicable conditions are set to expand over time. Some private insurers also are demanding more accountability instead of automatically paying for readmissions due to things like infections and poor care coordination.

“Readmissions happen for many reasons,” says David Bronson, president of the American College of Physicians and an internist at the Cleveland Clinic in Cleveland, Ohio. “What we’re trying to reduce are the ones that could [have been] prevented if we’d planned better.”

Nearly one in five Medicare enrollees are readmitted to a hospital within 30 days of their initial stay, accounting for an estimated $15 billion in annual spending, according to a 2007 report from the Medicare Payment Advisory Commission, a nonpartisan government agency that advises Congress about Medicare.

In general, hospitals are responsible for 80% of what drives their readmissions, while lack of patient compliance accounts for 20%, says Rich D’Alberto, chief executive of the Laurens County Health Care System in Clinton, S.C.

Of course, newly discharged patients can’t always avoid re-hospitalization. But there are things you or a trusted surrogate can do to lower your chances, according to doctors and hospital administrators.

Be involved. Insist on being part of the care team from the time you’re admitted. Ask health-care providers to write the shift-change report at your bedside so you can participate and set goals for your hospital stay, says Sandra Thompson, administrator of quality and compliance for the Laurens County Health Care System.

Understand your discharge plan. At discharge, go over your care plan with someone who can correct you if you miss or confuse something—especially if you’re changing medications or facing new dietary restrictions. “Say, ‘I’d like to go over these papers and make sure I do it right when I leave,’” suggests Dr. Bronson. Get help if the language is unclear or riddled with acronyms. If you have any pending test results, ask to have that documented in your discharge record so the results aren’t forgotten at your follow-up visit.

Ask for help. Alert the discharge planner if you can’t afford your medications or can’t get transportation to the doctor’s office. The hospital should be able to help you access drug-discount programs and connect you with nonprofit or community groups that drive patients to their medical appointments.

Keep appointments. Once out of the hospital, see your primary-care doctor or surgeon within the first week or two. If you don’t have a doctor, ask the hospital staff to set you up with one at a community health center or other site. Don’t be afraid that your physician will put you back in the hospital if you see him or her. By adhering to your discharge instructions and partnering with your doctor, you may lower your chances of having to return.

Watch for symptoms. Know your condition and act fast if symptoms worsen. Heart-failure patients, for example, should call their doctor right away if their daily weight creeps up, their ankles swell or they get shortness of breath, Dr. Bronson, says.

“Don’t panic, but know what to expect if things go off track and have a plan for what you’re supposed to do,” he says. Symptoms from other chronic conditions such as arthritis, depression or diabetes can complicate a recovery and need to be communicated.

Communicate with your doctor. Don’t be afraid to “bother” doctors with your questions or concerns. That’s what they’re there for, Dr. Bronson says. “If you don’t bother them when you’re sick, when are you going to bother them?”

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